To contest the insurance company’s denial, your friend can follow these steps:
Review the Policy Terms: Obtain a copy of her insurance policy and thoroughly review it to understand coverage details, specifically regarding water damage and pre-existing conditions.
Gather Evidence: Collect all relevant documentation, such as property inspection reports, photographs of the damage, maintenance records, and any communications with the insurance company.
Get an Independent Assessment: Hire a professional contractor or an independent adjuster to assess the damage. Their report could provide a neutral perspective on the cause and development of the leak, potentially contradicting the insurance company’s claim.
Draft a Formal Appeal: Write a formal appeal letter to the insurance company citing evidence from the independent assessment and policy terms. Clearly articulate why the damage should be covered, emphasizing any unclear policy language or overlooked evidence.
Contact a Public Adjuster: Consider hiring a public insurance adjuster to negotiate with the insurance company on her behalf. Public adjusters work independently from insurers and advocate for the policyholder.
Consult with an Attorney: If the appeal is denied, seek advice from an attorney experienced in insurance claims. They can provide legal insight and help you consider litigation, if necessary.
File a Complaint with State Regulators: If all else fails, she can file a complaint with her state’s department of insurance, which oversees insurers and can investigate unfair claim denials.
Stay Persistent: Throughout the process, maintain detailed records of all communications and remain persistent in following up with both the insurance company and any professionals involved.
By systematically pursuing these steps, she can build a strong case to challenge the denial and increase the chances of a successful appeal.
